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Perfusion Parameters at Dynamic Contrast-enhanced Breast MR Imaging are Associated with Disease-Specific Survival in Patients with Triple-Negative Breast Cancer1Radiology, Yonsei University College of Medicine, Seoul, Korea, Republic of
Synopsis
We investigated the association between perfusion parameters in pretreatment MR imaging and survival outcome. This retrospective study included 61 consecutive patients (median age, 50 years; range, 27-77 years) diagnosed with TNBC who underwent pretreatment DCE breast MR imaging and definitive surgery. The median follow-up time was 46.1 months. Among pretreatment variables, a higher ve value and higher peak enhancement at pretreatment MR imaging were significantly associated with worse disease-specific survival in patients with TNBC. With further validation, these perfusion parameters have the potential to aid in the pretreatment risk stratification of patients with TNBC and in evidence-based clinical decision support.
Purpose
To investigate the association between perfusion parameters in pretreatment MR imaging and survival outcome (disease-free survival [DFS], disease-specific survival [DSS]) in patients with triple negative breast cancer (TNBC).Methods
Sixty-one consecutive patients (median age, 50 years; range, 27-77 years) diagnosed with TNBC with or without axillary lymph node metastasis and who underwent pretreatment DCE breast MR imaging and definitive surgery were included. MR examinations were performed using one 3-T MR scanner (TrioTim; Siemens, Erlangen, Germany), of which T1-weighted dynamic contrast-enhanced MR imaging included one precontrast acquisition and six postcontrast bilateral axial acquisitions (TR/TE, 280/2.6; matrix, 512 × 343 pixels, field of view 340 × 340 mm; section thickness 3mm, no intersection gap). For calculation of perfusion parameters, post-processing of DCE MR data was performed with dedicated post-processing software (Olea Sphere v2.3, Olea Medical, La Ciotat, France). For model-based perfusion parameters, pharmacokinetic analysis of DCE-MRI data was performed based on the extended Tofts model. Values for signal enhancement ratio (SER) and peak enhancement were estimated directly from the time-signal intensity curves.
We retrospectively analyzed clinical-pathologic variables and MR imaging parameters. Cox proportional hazards models were used to analyze the hazard ratio (HR) with 95% confidence intervals (CI) for disease-free survival and disease-specific survival with variables obtainable before treatment and with post-treatment clinical-pathologic variables. Additionally, cutoff points were determined for perfusion parameters significant at univariate analysis using the Contal and O’Quigley method.
Results
The median follow-up time was 46.1 months (range, 13.9-58.4 months). Eleven of 61 (18.0%) patients had events and seven (11.4%) died from breast cancer. Among pretreatment variables, a larger tumor size on MR images (HR = 1.024, P = .003) was associated with worse DFS at univariate analysis. A higher Ktrans value was associated with worse DFS with borderline significance (HR = 1.113, P =.056). Among post-treatment variables, a larger pathologic tumor size at surgery (HR = 1.106, P < .001), presence of metastasis in surgically resected axillary LNs (HR = 9.382, P < .001), receipt of total mastectomy (HR = 10.205, P = .003) and not receiving radiation therapy (HR = 6.912, P = .001) were independently associated with worse DFS. At multivariate analysis of post-treatment variables, a larger pathologic tumor size at surgery (HR = 1.074, P = .005) and the presence of metastasis in surgically resected axillary LNs (HR = 5.789, P = .017) were associated with worse DFS.
Among pretreatment variables, a higher ve value (HR = 1.624, P = .049), higher peak enhancement (HR = 1.335, P = .039), and a larger tumor size on pretreatment MR images (HR = 1.044, P = .002) were associated with worse DSS at univariate analysis. The statistically determined best cutoff points for perfusion parameters were as follows: 0.48 for ve and 96.17 for peak enhancement. A ve value greater than 0.48 (HR = 13.933, P = .014) and a peak enhancement value greater than 96.17 (HR = 13.933, P = .038) was associated with worse DSS. In multivariate pretreatment models for DSS, a higher ve value (HR=1.658, P=.038), higher peak enhancement (HR=1.843, P=.018) and a larger tumor size on MR images (HR=1.060, P=.001) were associated with worse DSS. In multivariate post-treatment models, a larger pathologic tumor size (HR=1.050 ,P=.042) and metastasis in surgically resected axillary lymph nodes (HR= 23.717 ,P =.002) were associated with worse DSS.
Conclusion
A higher ve value and higher peak enhancement at pretreatment MR imaging were significantly associated with worse disease-specific survival in patients with TNBC. After validation by large-scale studies, these perfusion parameters have the potential to aid in the pretreatment risk stratification of patients with TNBC and in evidence-based clinical decision support.Acknowledgements
We would like to thank Hye Sun Lee for her advice and assistance in statistical analysis.References
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